Only 14 states post hospital data on surgical site infections

Less than half of U.S. states require hospitals to report surgical site infections, and only a fraction of these states have publicly posted the information for patients to use in deciding where to seek care, said a study published online March 2 in the Journal for Healthcare Quality.

Twenty-one states require reporting of infections acquired during surgical procedures such as coronary artery bypass grafts and hip and knee replacements. Only 14 of these states have so far posted any of the information publicly. Moreover, states differ on data collection procedures and risk-adjustment standards.

“I think the states slowed down their [public reporting] efforts because people assumed that this is a cause that’s going to be taken on by Medicare,” said Martin A. Makary, MD, MPH, the study’s lead author. “Medicare’s made some steps, but they are so small and incremental that they’re not really influencing consumer choices about where to go for medical care.”

In January 2012, hospitals were required to start reporting surgical site infections for hysterectomies and colectomies to the federal government. That information will be posted within the year to the Centers for Medicare & Medicaid Services’ Hospital Compare website. But Dr. Makary said that publicly reporting infections for a sliver of all surgeries could mislead patients and divert quality initiatives.

“A lot of attention to a select few procedures disproportionately pulls hospital resources to emphasize improvement on those publicly reported items at the expense of other important quality improvement initiatives and needs at a hospital,” said Dr. Makary, associate professor of surgery at Johns Hopkins University School of Medicine in Baltimore and author of the forthcoming book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.

So far, not much evidence has emerged to show that public reporting of quality data leads to a measurable improvement in patient outcomes. But public-reporting proponents argue that is because the transparency movement in health care has not advanced quickly and broadly enough.

Patients and health care quality would benefit from standardized, nationwide public reporting of more surgical site infections, said John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center.

“It is frustrating to see how long it takes our health system to step up to real accountability,” Dr. Santa said.